Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
J Clin Neurosci. 2024 Nov;129:110863. doi: 10.1016/j.jocn.2024.110863. Epub 2024 Oct 15.
Chronic Subdural Hematoma (CSDH) is one of the most common neurosurgical pathologies. Due to an elderly demographic with increasing co-morbidities, surgery is often deferred out of hours. This may reduce complication risk, but increases length of stay and may compromise patient care due to delayed surgery. We performed a retrospective service evaluation of CSDH patients undergoing primary surgery (September 2021-September 2023) at a tertiary neurosciences centre. Out of hours (OOH) was defined as an operation start time outside 8 am-8 pm. Primary outcome was recurrence requiring repeat surgery. Secondary outcomes included complications, thromboembolic events (DVT/PE), length of stay, and in hospital mortality. Differences were assessed using Chi-Squared tests and Student's t-tests. A total of 263 patients were included (200 (76.0 %) male, mean age 75.0 ± 11.3 yrs). Median time from admission to surgery was 37 h (IQR 14-71.5 h). In total, 49.8 % (131/263) of operations took place OOH. There were no significant differences in baseline characteristics between the two groups. At a median follow-up of 9.2 months (IQR 4.8-13.2 months) there was no difference in recurrence rates between OOH and in hours groups (14.5 % vs. 17.7 %, p = 0.483). There was no difference in complication rates (13.7 % vs 16.2 %, p = 0.585), thromboembolic events (3.8 % vs 3.1 %, p = 0.743), length of stay (mean 15.9 vs 15.2 days, p = 0.787), or in-hospital mortality (2.3 % vs 3.1 %, p = 0.483). OOH surgery for CSDH surgery is safe, does not appear to affect complications, recurrence, or mortality, and should be considered in appropriately selected cases.
慢性硬脑膜下血肿（CSDH）是最常见的神经外科疾病之一。由于老年人口中合并症的增加，手术通常在非工作时间进行。这可能会降低并发症的风险，但会延长住院时间，并可能由于手术延迟而影响患者的护理。我们对一家三级神经科学中心的 CSDH 患者进行了原发性手术（2021 年 9 月至 2023 年 9 月）的回顾性服务评估。非工作时间（OOH）定义为手术开始时间不在上午 8 点至晚上 8 点之间。主要结果是需要再次手术的复发。次要结果包括并发症、血栓栓塞事件（DVT/PE）、住院时间和住院死亡率。差异采用卡方检验和学生 t 检验进行评估。共纳入 263 例患者（200 例[76.0%]为男性，平均年龄 75.0±11.3 岁）。从入院到手术的中位时间为 37 小时（IQR 14-71.5 小时）。总共有 49.8%（131/263）的手术在 OOH 进行。两组患者的基线特征无显著差异。在中位随访 9.2 个月（IQR 4.8-13.2 个月）时，OOH 组和非 OOH 组的复发率无差异（14.5% vs. 17.7%，p=0.483）。并发症发生率（13.7% vs. 16.2%，p=0.585）、血栓栓塞事件（3.8% vs. 3.1%，p=0.743）、住院时间（平均 15.9 天 vs. 15.2 天，p=0.787）或住院死亡率（2.3% vs. 3.1%，p=0.483）无差异。对于 CSDH 手术，OOH 手术是安全的，似乎不会影响并发症、复发或死亡率，并且在适当选择的情况下应予以考虑。
